Provider Demographics
NPI:1538276506
Name:SCHNEIDER, LOREN JESSE (DPM)
Entity type:Individual
Prefix:DR
First Name:LOREN
Middle Name:JESSE
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 SOUTH PARKWAY
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07014
Mailing Address - Country:US
Mailing Address - Phone:973-779-2149
Mailing Address - Fax:973-779-2149
Practice Address - Street 1:341 SOUTH PARKWAY
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07014
Practice Address - Country:US
Practice Address - Phone:973-779-1614
Practice Address - Fax:860-647-0449
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000177213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
061049069OtherCIGNA
061049069OtherAMERIHEALTH
1499420OtherGHI
061049069OtherUNITED HEALTH CARE OF NJ
OR2108OtherOXFORD
076189Medicare ID - Type Unspecified
061049069OtherCIGNA